What is bioethics? Bioethics is the study of ethical practices within medical and biological research. While seemingly complicated and obscure, the ethics of these fields can get quite interesting- especially as technology advances, and especially when accounting for all of the strange and particular situations that occur in hospitals.
Doctors and researchers are professionally trained for their jobs, knowing how to help people in dire scenarios and establishing new ways to do so. They are not however, professionally trained to make critical decisions concerning ethics. This job is left to bioethicists. They can either work alongside lawyers and legislators to implement core policies that make our hospitals and labs run ethically, or they can work in hospitals handling the obscure cases that walk through the door when there is a lack of policy that applies to the specific scenario.
Because bioethicists work on varying things anywhere from daily policy on patient treatment to more bizarre questions such as the ethics of cloning, the field is best exemplified through specific examples.
What would you do as a doctor in the emergency room if an unidentified man came in suffering cardiac arrest and needed to be resuscitated? If the man was identified, doctors must look at his records prior to resuscitation to see if he has a DNR form. A DNR form is “an order not to attempt CPR in the event a patient suffers cardiac or respiratory arrest.” If a patient is unidentified, protocol would allow doctors to attempt CPR.
Due to the ethical complications of DNR forms, their use and terms are laid out extensively for patients and physicians. These protocols, however, cannot account for all scenarios.
Doctors in Miami, Florida faced an extraordinarily difficult situation when an unidentified, unconscious man was delivered to their emergency room. Without access to his records, a decision had to be made regarding resuscitation. While this may seem like an ordinary occurrence, this man happened to have “Do Not Resuscitate” tattooed across his chest, with an apparent signature below it.
Initially, doctors worked to have the man regain consciousness using reversible measures. However, these efforts did not bring the man back. They then had to decide on beginning CPR, despite the mans tattoo’d wishes. When students graduate medical school and become doctors, they swear to abide by an ethical code called the Hippocratic Oath. Following this oath, the doctors in Miami thought pursuing CPR best adhered to the principle of not choosing an irreversible path when faced with uncertainty.
Yet, the tattoo was a very blatant statement that could not be ignored. Instead of wasting time grappling with the issue themselves, the doctors decided to consult their hospitals team of bioethicists. While waiting for the ethics team to finish consulting, the doctors in the emergency room were able to place the man on medications to preserve his life.
Because this case was so fascinating, it has become a large topic of debate for bioethicists. And while we cannot know for sure what the team debated over- we can certainly look into our own ethical objections to this scenario.
A tattoo can be many things. It must be taken into consideration that it could have been a drunken mistake, a dare, or something that was done years prior that no longer reflects the individuals actual thoughts or beliefs. It is not uncommon to find people who regret tattoos, as they are in fact, permanent. However, it must also be considered that a tattoo, due to their permanent nature, is often well thought out and a true reflection of an individual. Because both scenarios are equally likely, the ethics of making a medical decision based off of a tattoo become shaky.
In this situation, the ethics team decided that this tattoo was most likely an effort for the mans wishes to be followed- and an extreme one at that. Because of this, the doctors did not attempt resucitation and a DNR form was written out of his best interests. The man died later that night without medical intervention. Once identified, doctors and the ethical team were relieved to find that the man actually did have a DNR form.
While a correct decision was made in this scenario, many questions still remain. Is a tattoo a legally binding document? Should it be? Would the same decision be made from a different team of bioethicists?
The case report finished by saying they were neither in support or opposition of end-of-life wishes in a tattoo form to be granted. Because legislation and procedures were not outlined previously on how to handle a case like this, the hospital used their resources available to them to attempt to make the best decision possible for this particular man. But ethics are complicated, especially in the medical field. Much more deliberation and research must be done before actual procedures are outlined on this matter.
Bioethics is still a relatively new addition to the medical field, and cases like this one stress the importance of having an ethics team present in hospitals. There are no easy answers when it comes to patient care, and the questions will only get more complicated.
Sources:
https://www.bioethics.msu.edu/what-is-bioethics
Click to access do_not_resuscitate.pdf
https://www.nejm.org/doi/full/10.1056/NEJMc1713344?af=R&rss=currentIssue&#iid=f01
The Principle Of Not Choosing An Irreversible Path When Faced With Uncertainty
I have heard of the term ‘bioethics,’ in the past, but I never gave much thought as to what it truly was. I really enjoyed your article, it broadened my horizons on the interesting and pressing subject. I definitely agree that, given the tattoo example, an ethics team needs to be on call in hospitals. I would love to hear more examples, it is fascinating how much ethics plays a role in health care.
Initially I thought that the tattoo was intentionally in favor of a DNR form, as it was written across his chest, where compressions would be. However, after considering that he may have changed his mind, gotten the tattoo while intoxicated, or being tattooed because of a dare, I reconsidered. If I were on the ethics team, I would have agreed to resuscitate the man. Without having a legally binding document on hand, the hospital would be to blame if he had died without the DNR form. I am glad he did have a singed DNR, it worked out well for the ethics team and the hospital, as well as following the man’s wishes. However, it was a coin toss. If I were responsible for the man’s care and listened to his tattoo rather than assuming he had a DNR form, I would not want to take the chance. I would be the one to inform his family that he had died on my watch because of a misinterpretation of a tattoo.
I do not think a tattoo should be a legally binding document. I have a few tattoos and they are going to be on my body for the rest of my life. If I were stupid enough to get a “do not resuscitate” tattoo and had it for twenty years, but then built a family and changed my mind, that tattoo would still be on my body. I think it is too risky for a bioethics team to use a tattoo for a legally binding document.
Alyssa, remember you need to cite at least once source.
In comparison to most other civic issues, this blog was extremely open to personal interpretation. You wrote it in such a voice that calls upon the reader to actively consider the evidence provided to form his or her own opinion. At the end, there is no true “right” or “wrong” answer. Because of the nature of tattoos, the interpretation can be skewed by a strictly professional point of view.
Body art is considered precisely what the title suggests: it is an art form, and often has a spiritual or personal interpretation rather than an objective meaning. Therefore, from this perspective, the convention of a tattoo should not be considered a legally binding contract with any practical application- especially in a life or death scenario. For example, a popular tattoo includes the signature or initials of a loved one- this does not constitute the identity of the patient, and would not be used to identify a patient in the case that no record is provided. By the same accord, a DNR tattoo can not necessarily be interpreted to signify a patient’s preference for end of life protocol.
However, the DNR tattoo can provide useful insight to end of life protocol in the event that an unidentified patient is in need of CPR and other optional emergency care. For this reason, state legislators have provided an official list of accepted forms of DNR paperwork. These items vary across state boarders, but generally include cards, official forms, official necklaces and bracelets, and other notarized material (Konya). In most states, a tattoo is not included in this list and therefore will not be accepted as a form of patient identification or preference insight.
While a tattoo is in theory a useful and permanent form of identification for medical records, it proves unreliable when in practice. Because of the subjective nature of body art, interpreting tattoos can not be considered in the decision to provide adequate emergency care.
Works cited:
Konya, Matthew. “DNR Tattoos: Are They Legal and Is EMS Bound to Comply?” EMS1, 11 Jan. 2018, http://www.ems1.com/paramedic-chief/articles/372711048-DNR-tattoos-Are-they-legal-and-is-EMS-bound-to-comply/.
When I read the title of your blog, I got super excited because I knew it was going to be interesting. As I continued to read, I realized that I read an article previously about this situation, but I never went too in-depth with all of the details from the bioethicist perspective. Bioethics is a super complicated world. I know you mentioned cloning and that was my issue for my paradigm shift last semester, which is definitely another complicated issue with bioethics.
For my response to your blog, I decided to look up more information on DNRs in general. Apparently, they are more common than I thought and there are some that have a legal binding to them. Receiving cards, completed official forms, and approved bracelets or necklaces that are a form of DNR is like a legally binding contract. Different states have different regulations regarding DNRs. Based on this article, unless the state recognizes tattoos as a specific and valid DNR, the EMS practitioners should not have relied on a tattoo to make medical decisions. The main issue comes into play with the fact that you pointed out which is DNRs are not permanent, so something like a tattoo could have been old or irrelevant. The article goes on to say some additional information about tattoos as DNRs and states that they are not a valid form and EMS practitioners should not use tattoos as accepted.
Source: https://www.ems1.com/paramedic-chief/articles/372711048-DNR-tattoos-Are-they-legal-and-is-EMS-bound-to-comply/